Inspection on 25/11/08 for The Limes

This inspection was carried out on 25th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes 16/11/09

The Limes 23/01/08

The Limes 22/08/07

The Limes 01/08/06

The Limes 15/11/05

The Limes 02/06/05

The Limes 21/10/04

The Limes 02/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Limes 41/45 Church Street Bridgwater Somerset TA6 5AT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: kathy McCluskey     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Limes 41/45 Church Street Bridgwater Somerset TA6 5AT 01278422535 Telephone number: Fax number: Email address: Provider web address: angelbre2003@yahoo.co.uk Name of registered provider(s): Type of registration: Number of places registered: Mr Brian Thomas care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: An additional bathroom equipped with assisted bathing facilities will be installed within 10 months from Date of Registration Registered for 23 persons in category OP and 5 persons in category DE(E) The large pond in the rear garden is protected in a manner which prevent accidents to vulnerable service users, within 8 weeks of Date of Registration Date of last inspection Brief description of the care home The Limes is located in a quiet but central part of Bridgwater. It is currently registered with the Commission for Social Care Inspection to provide personal care to up to 28 people over the age of 65, this includes 5 people who have a dementia. The home is not registered to provide nursing care. Service user accommodation is arranged on 4 floors, with lift access to all floors. All communal areas are on the lower floors. The registered provider is Mr Brian Thomas. The home does not currently have a registered manager. The home is furnished in a comfortable domestic style. There are twenty0 0 Over 65 5 23 Care Homes for Older People Page 4 of 30 Brief description of the care home four single bedrooms and two double rooms. Twenty-three of the bedrooms have en suite facilities. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over one day (9.5hrs) by CSCI Regulation Inspector Kathy McCluskey and the Commissions regional lead pharmacist inspector, Brian Brown. The acting manager and a representative of the registered provider were available throughout this inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection were made available to us. At the time of this inspection, 19 people were living at the home and we were able to meet with 17 of them during our inspection. All but three people were able to clearly express their views. We were also able to speak to 7 members of staff. Comments have been included in this report as appropriate. Care Homes for Older People Page 6 of 30 The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 30 No requirements were raised at the last inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home and services offered is available to people using the service and those who are thinking about using the service. The home ensures that people are appropriately assessed before a placement is offered. Systems are in place to ensure that the assessed needs of people can be met, though the home need to ensure that all staff have the skills and knowledge to meet the needs of people with dementia care needs. Evidence: The home have produced a Statement of Purpose and Service User Guide which provides people with information about the home and services offered. We were not informed of any changes to these documents. We spoke with two people who had Care Homes for Older People Page 11 of 30 Evidence: recently moved to the home. Both confirmed that, before they decided to move to the home, their relatives had visited the home on their behalf. Care plans contained evidence that people had been assessed by the home before they were offered a placement. Assessments from other health care professionals were also in place. During this inspection we spoke with 17 of the 19 people using the service. Three people were unable to express themselves verbally so we spent time observing these people at various times throughout the day. Every person spoken with during this inspection told us that they felt their needs were met by the staff. No concerns were raised with us. We spoke to all care staff on duty and all felt that they were able to meet the assessed needs of people currently at the home. We were informed that district nurses are currently visiting 6 people at the home to monitor and dress sores for 4 people and to manage catheter care for 2 people. The acting manager and staff spoken with informed us that there was nobody currently at the home that was unable to mobilise or who required the use of a hoist for transfers. This was also confirmed by staff spoken with. We were able to see that people had appropriate walking aids where required. Two care staff who had been employed earlier this year, confirmed that they had not received training in dementia care. Other staff spoken with told us that they had received training last year. As the home is currently registered to take up to 5 people with dementia, the home should ensure that all staff receive appropriate training at least annually. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans generally contain sufficient information to enable staff to meet peoples needs, though care plans are not always raised to address all assessed needs. The home ensure that people have access to appropriate health care professionals. The homes procedures for the management and administration of peoples medication requires improvements to ensure people are not placed at risk. People are treated with respect and their right to privacy is upheld. Evidence: During this inspection we looked at the care plans relating to 7 people using the service, all of whom we met with during the inspection. We were informed by the acting manager that she was in the process of introducing new care planning documentation to ensure that systems were more informative and efficient. Care Homes for Older People Page 13 of 30 Evidence: Care plans had been regularly reviewed and were up to date. Two care plans required more information to ensure that staff were able to meet the individuals assessed needs. One related to a person with epilepsy. There was some basic information available to staff which stated that if staff are concerned then ring for an ambulance, It also mentioned that the individual, usually comes round quickly. This had been recorded under current health needs but a detailed plan of care had not been developed. We have made a requirement that the home ensure that a plan of care is developed which identifies the individuals needs and gives clear instructions for staff as to actions to be taken. This should include signs and symptoms of a seizure, actions to be taken by staff both during and following the seizure and what action to be taken where there are concerns. The home also need to ensure that a separate record of all seizures is maintained as this is currently recorded on the daily record sheets and it is difficult to find the information. The home monitors peoples weights on a monthly basis. We noted that a significant weight loss had been identified for one person between October and November but a care plan had not been raised to address this. Daily records examined did not make any reference to the weight loss and did not contain any information regarding dietary intake. It has been required that the home takes appropriate steps to address this. Care plans contained evidence that people had access to appropriate health care professionals. Records of all visits are maintained within the plan of care. We found that medicines were all stored securely and in accordance with the current regulations. When looking through the medicines in use we found that no record of opening had been made for eye drops currently in use. For three of these bottles the date of dispensing was more than 28 days before the inspection. If these had been opened then it would be placing the people receiving them at risk of possible infection or receiving an ineffective product. These were taken out of use during the inspection and replacements were placed in the trolley and dated with the date of opening. For one person we found that for two of their medicines, no stock was available and they had not received the medicines for 2 days. It was confirmed that these medicines had been reordered and a replacement supply was received during the day. For another person it was observed that they had run out of their pain relief medicines, and the member of staff administering medicines told us that they were currently using the homes supply of Homely Remedies to fulfil this need. However the box of medicine being used was a prescription only medicine and therefore not appropriate for use as a Homely Remedy. We found that some people were supported to manage the application of their own creams and lotions. The supply of these medicines is recorded and a basic risk assessment was seen within their care plans. However when we looked in one persons room with the Home Manager, it was not possible to find any Care Homes for Older People Page 14 of 30 Evidence: secure storage. We could also find no record of any monitoring of use as defined in the risk assessment having taken place. We found that most Medication Administration Record (MAR) charts are printed by the supplying pharmacy, but some are hand written at the home, and these were seen to be signed and dated by two people to minimise the risk of error. However we found that a printed chart for one person had been amended to indicate that they were to receive a higher dose. The record made indicated that the higher dose had been administered but when checking the stock in the cupboard it was apparent that they were receiving the lower dose. As the record indicated that the higher dose had been administered it is possible that when the prescriber next reviews this person, that they may further increase the dosage and this could have a possible adverse effect. As previously mentioned, during this inspection we met with 17 people using the service and all confirmed that the staff treated them with respect and that their privacy was upheld; The staff help me with a bath and I have no complaints, The staff are very kind, I dont need much help from staff though they do help me with a bath and they will leave me in private, The staff are very good and they talk to you in a nice way, They help me with a bath and I have no worries and they always knock on my door, I can choose how and where to spend my day. People appeared relaxed in the presence of staff and we heard staff communicating with people in a kind and respectful manner. People responded positively to staff and were happy to engage in conversation. People looked clean and well attired. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available at the home and people told us that they were satisfied with the current provision. Visitors are made to feel welcome and people can choose where to see their visitors. People are offered a wholesome and varied diet. Evidence: We were informed by the home that an activities co-coordinator is employed for two hours, two mornings a week. Fourteen people using the service were able to tell us about the provision of activities at the home. The general consensus was that there was plenty going on if you wanted to join in; One of the carers comes in as extra on a Monday and Thursday to do activities, last week we had the Prince of Wales Trust, we have a regular quiz, bingo and a sing a long, There is enough going on, There are plenty of things going on if you want to join in, I particularly like the bingo and quizzes, I choose not to join in as I prefer to read, We also have the hairdresser once a week which I enjoy. During this inspection, the majority of people were observed utilising the main lounge areas. Some people were reading Care Homes for Older People Page 16 of 30 Evidence: newspapers/magazines, 3 people were completing a crossword and 2 were knitting. The atmosphere was relaxed and people confirmed that they could choose how to spend their day. An activities record is maintained and records were examined at this inspection. Individual records are maintained for each person using the service. Records include details of each persons abilities and preferences and an entry for each activity undertaken which includes the outcome for the individual. We noticed that records for some individuals did not demonstrate that they were always offered regular activities. Records relating to two people had not had an entry made since August. We discussed this at the time and were informed that people were always offered activities, but sometimes did not want to join in. It has been recommended that the home makes a record on the individuals activity sheet, of the activity offered and that it was refused including the reason where appropriate. People told us that their visitors were always made to feel welcome and that they were offered refreshments. We did not see any visitors on the day of this inspection. Fifteen of the seventeen people spoken with during this inspection were very positive about the meals available at the home; The food is very good and there is plenty to eat, There is plenty to eat and I have put on so much weight since I have been here, You get two choices at meal times and the staff come round and ask you what you would like, We have our main meal then at tea time we have soup or sandwiches and then at supper we have more sandwiches or cake, The food is excellent and you have a choice of meals, What is nice is that you can order a small, medium or large meal. When asked, people confirmed that the home were aware of their preferences with regard to food and drink. They know that I dont like runner beans and that I like strong tea, They know that I cant eat chicken. During the inspection we observed staff asking each person what their preferences were for the next meal. Records are maintained. We were able to speak to the homes cook who confirmed that there was always plenty of food and that extras and snacks were always available. The cook also confirmed that they are made aware of peoples preferences and special diets and that a list is held in the kitchen. The cook stated that people benefit from good home cooking. Menus were seen and choices appeared wholesome and varied. A full roast is offered twice a week. On examination of peoples weight charts, apart from one individual, people appeared to be maintaining or gaining weight. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are investigated in line with the homes procedures and people living at the home feel confident in raising concerns. Procedures are in place to reduce the risk of harm or abuse to people living at the home. Evidence: The home displays an appropriate complaints procedure which is displayed in the reception area of the home. We asked people living at the home if they knew how to make a complaint and whether or not they would feel confident in raising any concerns. All confirmed that they did know how to make a complaint and that they would feel confident. None of the people living at the home raised any concerns with us during this inspection. We examined the homes complaints records. There were 13 recorded complaints and the documents reviewed indicated that these were all responded to within the timescales as defined in the policy. Many of these complaints relate to staff issues. The homes last key inspection was conducted in January of this year and since then the Commission have been jointly involved in investigating safeguarding issues. Action was taken at the time of the investigation to safeguard the people using the service. Care Homes for Older People Page 18 of 30 Evidence: The home has a copy of Somersets revised policy (May 2007) on Safeguarding Adults. We spoke to 7 members of staff during this inspection and all but one confirmed that they had received training in the prevention of abuse. All confirmed that they were aware of the whistle blowing policy. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and homely environment where they can personalise their own bedrooms. Appropriate procedures are in place to reduce the risk of the spread of infection. Evidence: During this inspection we were able to view all communal areas of the home. All areas were clean, warm and comfortably furnished and people appeared relaxed in their surroundings. The home promotes a homely feel. There are 26 bedrooms, 24 singles and 2 doubles. 23 of the bedrooms have en-suite toilet facilities. There are communal bath/shower rooms on the ground floor, lower ground floor and second floor. People told us that they were happy with their rooms; My room is lovely, all warm and clean, I am very pleased with my room and I have everything I need. A call bell system is installed throughout the home. People told us that call bells were responded to promptly by staff. Care Homes for Older People Page 20 of 30 Evidence: Systems are in place to reduce the risk of the spread of infection. Staff hand washing facilities are appropriately sited and staff have access to protective clothing. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are appropriate to the numbers and needs of people currently at the home. The home follows appropriate staff recruitment procedures. Staff receive appropriate training. Evidence: At the time of this inspection, nineteen people were living at the home. On the morning of this inspection, the following staff were on duty; Acting manager, assistant manager, senior carer and 2 care staff. In addition the the care staff, a cook and housekeeper were on duty. During the afternoon, the acting manager, assistant manager, 2 carers and housekeeper were on duty. We were informed that from 1800hrs to 2200hrs, 3 care staff would be on duty. Nights are covered by two waking carers. People living at the home did not express any concerns regarding staffing levels. People told us they felt that their needs were met by staff. They also commented on the kindness of staff; They are very good, very kind, I am definitely well cared for and the staff are very good, They treat you as an individual. We spoke to 7 members Care Homes for Older People Page 22 of 30 Evidence: of staff during this inspection and none raised any concerns regarding staffing levels at the home. We examined the homes procedures for staff recruitment. Three staff files were examined and these contained all required documentation. We were also able to see evidence that staff had not commenced employment until satisfactory criminal record checks (CRB) and checks against the protection of vulnerable adults register (POVA) had been received. We were able to see evidence that newly appointed staff had followed an appropriate induction programme. Staff training records were also examined. There are individual training profile records for each member of staff. However these were not all up to date. It was however possible to determine what training had been received by looking at the certificates held in the individual sections. Some of the more recently recruited people in particular did not have summary sheets of the training they had received. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home in the absence of a registered manager, have not always ensured the effective running of the home. A recently appointed acting manager is now in post. Some improvements are needed in the homes procedures relating to health and safety. Evidence: The home does not currently have a registered manager. An acting manager has been in post since October 2008. Prior to the acting manager taking up post, the home promoted a senior carer to oversee the management of the home. As highlighted in this report, deficits were noted in the homes procedures relating to care planning and the management and administration of medication. Interim management arrangements had not always ensured that these procedures were correctly followed and there were no systems in place to audit these procedures. Care Homes for Older People Page 24 of 30 Evidence: The home has quality assurance procedures in place which seeks the views of people using the service and their representatives. We were able to view some completed questionnaires which had been sent out in August of this year and comments were noted to be positive. Regular meetings are held for people living at the home. Minutes of a recent meeting were seen to be displayed in the home and people were invited to attend a meeting on the day of this inspection. There was some evidence that staff had received formal supervisions since the appointment of the acting manager. This was also confirmed by the staff members spoken with during the inspection. We looked at how the home was supporting three people to manage their finances. We found that appropriate records and receipts were being maintained. We checked the amount of money held against the balances shown and these were found to be correct. There was evidence of regular internal audits on balances and transactions. We examined the homes procedures for health and safety. A selection of records were examined and we toured the premises. It could not be ascertained whether some of the internal doors, which we found to be propped open, were designated fire doors. We have made a requirement that the registered person contacts the local fire officer to seek advice. Other doors marked as fire doors had been fitted with automatic door closures which are linked to the fire alarm systems. We have recommended that the home includes the zones checked on the in house checks on the fire alarm systems. Stickers on portable electrical appliances indicated that annual testing had last been carried out in August 2007. It has been recommended that the home ensures that all appliances are checked annually by a competent person. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 31/12/2008 ensure that care plans are raised to meet the needs of people with nutritional needs and where significant weight loss has been identified. This is to ensure that health care needs can be met 2 7 15 The registered person must ensure that care plans are raised to address peoples needs with regard to their epilepsy. This must include clear instructions for staff of action to be taken in the case of an emergency. A separate record should be maintained giving details of all epileptic seizures for the individual. To ensure that peoples health care needs can be fully met. 31/12/2008 Care Homes for Older People Page 27 of 30 3 9 13 Arrangements must be 31/12/2008 made to ensure that there is a system to monitor the availability of peoples medicines. This is to ensure that people receive their medicines as prescribed 4 9 13 Arrangements must be 31/12/2008 made to ensure that a system is in place to remove date expired products from use. This is to prevent people being administered products that are date expired and may be ineffective 5 38 13 13(4) The registered person 31/12/2008 must seek advice from the local fire officer on the internal doors which are marked as fire doors but are not connected to the fire alarm system. This is to ensure that there is no risk to the health and safety of persons at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 4 9 The home should ensure that all staff receive appropriate training in dementia care at least annually. It is recommended that the home develop audit systems to monitor the medicine administration records to pick up errors on charts. It is recommended that the home develop monitoring Page 28 of 30 3 9 Care Homes for Older People systems for those people looking after any of their own medicines. 4 12 The home should ensure individuals activity records also contain information about when an activity is offered and is refused by the individual. This should include details about the activity offered and, where appropriate, any reason that it was declined by the individual. The registered person should ensure that the zone checked is recorded on the homes internal fire alarm checks. The registered person should ensure that all portable electrical appliances are checked at least annually by a competent person. 5 6 38 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!